Wisconsin School-Based Services Medicaid Cost Report and Cost … · 2012-11-19 · Wisconsin School-Based Services Medicaid Cost Report and Cost Settlement Training Guide September

Wisconsin School-Based Services Medicaid Cost Report and Cost Settlement Training Guide September 2012 District User Training Guide

Wisconsin Medicaid Cost Report and Cost

Settlement Training

District Administrator Training Guide

© Public Consulting Group, Inc.

Table of Contents Part 1: Medicaid Cost Report

I. Accessing the Annual Medicaid Cost Report

II. General and Statistical Information

III. Direct Medical Services Other Costs Summary

IV. Direct Medical Services Equipment Depreciation

V. Transportation Payroll Information

VI. Transportation Other Costs

VII. Salary and Benefits Data Summary Report

VIII. Annual Edits ................................

IX. Claims Verification and Submission

X. Signature Page ................................

Part 2: Cost Settlement ................................

I. Releasing of the Cost Settlement Results

II. Medicaid Paid Claims Summary

III. Cost Settlement ................................



© Public Consulting Group, Inc. - September 2012

Part 1: Medicaid Cost Report ......................................................................................

I. Accessing the Annual Medicaid Cost Report ...........................................................

II. General and Statistical Information ................................................................

III. Direct Medical Services Other Costs Summary ....................................................

IV. Direct Medical Services Equipment Depreciation ................................

V. Transportation Payroll Information ................................................................

VI. Transportation Other Costs ................................................................

VII. Salary and Benefits Data Summary Report .........................................................

................................................................................................

IX. Claims Verification and Submission ................................................................

................................................................................................

..............................................................................................

Releasing of the Cost Settlement Results ...............................................................

II. Medicaid Paid Claims Summary ................................................................

................................................................................................

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Part 1: Medicaid Cost Report




Medicaid Cost Report

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I. Accessing the Annual Medicaid Cost Report The annual Medicaid Cost Report is completed on theReporting and Claiming System (MCRCS).browser and enter https://costreporting.pcgus.com/wi The username is the email addressnew users, passwords will be sent users will then be prompted to reset their password and create a security question after logging in for the first time. Select the Log In button after entering the username an

Note: If a password is forgotten, response to a security questionpassword to the user. If the user still has difficulty logging in, contact option 3.




Accessing the Annual Medicaid Cost Report

Cost Report is completed on the web-based Medicaid Cost ing and Claiming System (MCRCS). To access MCRCS, open an internet

https://costreporting.pcgus.com/wi.

email address submitted to Public Consulting Group (PCG)asswords will be sent via an auto-generated email from MCRCS

prompted to reset their password and create a security question after

after entering the username and password.

forgotten, select the Forgot Password link. Provide response to a security question. The system will then send a new, auto-generated

If the user still has difficulty logging in, contact 1-877

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Medicaid Cost MCRCS, open an internet

submitted to Public Consulting Group (PCG). For from MCRCS. New

prompted to reset their password and create a security question after

Provide a correct generated

877-395-5019,


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Once logged in, the Dashboarddue dates, training information, and resourcescontact information if the district needthrough the various sections of MCRCS using the menu bar at the top Note: For assistance completing the Medicaid Cost Report or understanding the cost settlement process, contact the PCG Medicaid Cost Report support team at [email protected] or (877) 395

To access the Medicaid Cost Reportthe menu screen. Once the userfollowing screen will appear:




Dashboard page will appear. The Dashboard displaysdates, training information, and resources. The Dashboard also displays PCG’s

district needs additional support. The user can through the various sections of MCRCS using the menu bar at the top.

: For assistance completing the Medicaid Cost Report or understanding the cost settlement process, contact the PCG Medicaid Cost Report support team at

or (877) 395-5019, option 3.

Medicaid Cost Report, select the Medicaid Cost Report link

the user has selected the Medicaid Cost Report link,

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displays important also displays PCG’s

The user can navigate

: For assistance completing the Medicaid Cost Report or understanding the cost settlement process, contact the PCG Medicaid Cost Report support team at

link at the top of link, the


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Select the appropriate reporting period from the dropdown corner of the page.




Select the appropriate reporting period from the dropdown options at the upper right

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options at the upper right


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II. General and Statistical Information To access the General and Statistical Informationselect the General and Statistical Information

Once selected, the General and Statistical Information




and Statistical Information

General and Statistical Information portion of the Medicaid Cost ReportGeneral and Statistical Information link.

General and Statistical Information page will appear:

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Medicaid Cost Report,


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Several sections on the General and Statistical Informationpopulated by PCG. These include:Wisconsin Uniform Financial Accounting Requirements Indirect Cost Rate, and the Direct Medical Services PercentagePool and SBS Group 2 Cost Pool) Information for the following categories will need Individualized Education Program (Transportation Trips Ratio and the Note: The Transportation Ratios are only required when transportation costs. Additionallyrequired when reporting “not only specialized transportation” costs. National Provider Identification NumberThe NPI number is a ten digit identification number issued to health care providers by the Centers for Medicare and Medicaid Services Wisconsin Uniform Financial Accounting RequirementsThe WUFAR number is used to identify the district according to the Wisconsin Financial Accounting Requirements Unrestricted Indirect Cost Rate (UICRThe UICR represents the district indirect costs incurred during the reporting periodnecessary for the general operation of the calculated by the state of Wisconsin. Direct Medical Services Time Study Percentages The Direct Medical Service Time Study Presults of the quarterly Random Moment Time StudyRMTS are coded, specific codes identify providers spend actually performing direct medical servicespercentage is a statewide averagereporting period. There is one Direct Medical Service percentage for each cost pool. Specialized Transportation Trips RatioThe Specialized Transportation Trips Ratio isSpecialized Transportation costs. Specialized Transportation refers toeducation students whose Individualized Education Plan (IEP) states the specific needfor specialized transportation. Handbook states that specialized transportation




General and Statistical Information page have been populated by PCG. These include: the National Provider Identification (NPI)Wisconsin Uniform Financial Accounting Requirements number (WUFAR)

Direct Medical Services Percentage (SBS Group 1 Cost Pool and SBS Group 2 Cost Pool).

Information for the following categories will need to be entered by the district: d Education Program (IEP) Ratio, and, if applicable, the Specialized

and the Specialized Transportation Vehicle Ratio

Transportation Ratios are only required when the district has reportedAdditionally, the Specialized Transportation Vehicle Ratio

“not only specialized transportation” costs.

ational Provider Identification Number (NPI): digit identification number issued to health care providers by

Centers for Medicare and Medicaid Services (CMS).

isconsin Uniform Financial Accounting Requirements Number (WUFAR)used to identify the district according to the Wisconsin

equirements.

Unrestricted Indirect Cost Rate (UICR): district indirect costs incurred during the reporting period

necessary for the general operation of the district. This rate is district-specific and Wisconsin.

Services Time Study Percentages By Cost Pool Time Study Percentage is calculated according to the

Random Moment Time Study (RMTS). When the results of the RMTS are coded, specific codes identify the average time direct medical service

performing direct medical services. The direct medical percentage is a statewide average of three quarterly time periods within the cost

There is one Direct Medical Service percentage for each cost pool.

Transportation Trips Ratio ized Transportation Trips Ratio is required by all districts who report

Specialized Transportation costs.

refers to transportation services provided to special education students whose Individualized Education Plan (IEP) states the specific needfor specialized transportation. The Wisconsin Medicaid School Based Services Handbook states that specialized transportation includes, but is not limited to: a

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been pre-National Provider Identification (NPI) number,

(WUFAR), Unrestricted (SBS Group 1 Cost

tered by the district: Specialized

Specialized Transportation Vehicle Ratio.

reported ed Transportation Vehicle Ratio is only

digit identification number issued to health care providers by

UFAR): used to identify the district according to the Wisconsin Uniform

district indirect costs incurred during the reporting period specific and is

calculated according to the . When the results of the

time direct medical service The direct medical

thin the cost There is one Direct Medical Service percentage for each cost pool.

required by all districts who report

transportation services provided to special education students whose Individualized Education Plan (IEP) states the specific need

The Wisconsin Medicaid School Based Services includes, but is not limited to: a


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physically modified vehicle with a ramp or lift; a vehicle where an aide is required to assist the child; a specially adapted bus for a child with a disability who is not able to ride a standard school bus and/or a vehiclfor Medicaid reimbursement must be for tnecessary in order for them todirect medical service must be The Specialized Transportation Trips Ratio is used to specialized transportation costsby the district. The Specialized Transportation Trips Ratio is made up of the “Total Number of OneWay Trips for Medicaid SPED Studentstheir IEP)” (numerator) over the “Total Number of One(both Medicaid eligible and non this ratio, follow the instructions below. Numerator of the Specialized Transportation Trips RatioTo calculate the numerator, the Students”: 1. Identify the Medicaid eligible

in their IEP; 2. From this list of students, identify the total number of days in which each

received a direct medical service; then,3. Count the actual number of one

received the direct medical service documentation. Note: School districts musteducation students receiveddocumentation includes: specializedequivalent documentation that proves the special education student took one or two trips the same day they received a Me

Denominator of the Specialized Transportation Trips RatioTo calculate the denominator, the1. Identify all special education

with specialized transportation 2. Count the number of one-way

present at school (one or twothat day.




physically modified vehicle with a ramp or lift; a vehicle where an aide is required to assist the child; a specially adapted bus for a child with a disability who is not able to ride a standard school bus and/or a vehicle following a specialized route.for Medicaid reimbursement must be for transportation services provided to students necessary in order for them to receive a Medicaid-covered direct medicaldirect medical service must be documented in the student’s IEP.

The Specialized Transportation Trips Ratio is used to allocate the Medicaidspecialized transportation costs from the total specialized transportation costs

tion Trips Ratio is made up of the “Total Number of OneWay Trips for Medicaid SPED Students (receiving a direct medical service pursuant to

the “Total Number of One-Way Trips for SPED Students”both Medicaid eligible and non Medicaid eligible students) (denominator).

this ratio, follow the instructions below.

of the Specialized Transportation Trips Ratio , the “Total Number of One-Way Trips for Medicaid

Medicaid eligible students that have specialized transportation services

From this list of students, identify the total number of days in which each ceived a direct medical service; then,

actual number of one-way trips the student took on the days in which they received the direct medical service (one or two trips), as supported by

School districts must document each trip that the Medicaid eligible education students received and retain this supporting documentation

specialized transportation bus logs, attendance sheetsdocumentation that proves the special education student took one or two

trips the same day they received a Medicaid covered direct medical service

of the Specialized Transportation Trips Ratio To calculate the denominator, the “Total Number of One-Way Trips for SPED Students

special education students (Medicaid eligible and Non-Medicaid eligible) ransportation services in their IEP; then,

way trips the student took on the days in which they were (one or two trips), regardless of whether they received a service

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physically modified vehicle with a ramp or lift; a vehicle where an aide is required to assist the child; a specially adapted bus for a child with a disability who is not able to

e following a specialized route. Costs eligible provided to students

direct medical service. This

Medicaid-allowable specialized transportation costs reported

tion Trips Ratio is made up of the “Total Number of One-(receiving a direct medical service pursuant to

Way Trips for SPED Students” ). To calculate

Medicaid SPED

portation services

From this list of students, identify the total number of days in which each student

the days in which they as supported by

Medicaid eligible special documentation. Acceptable

, attendance sheets or documentation that proves the special education student took one or two

dicaid covered direct medical service.

Way Trips for SPED Students”: Medicaid eligible)

the student took on the days in which they were , regardless of whether they received a service


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To enter the Specialized Transportation Trips Ratio numerator and denominator, Edit.

Once entered, select Update. erroneously.

Specialized Transportation Vehicle Ratio The Specialized Transportation Vehicle Ratioonly specialized transportation” costs are reported. Note- If a district can discreetly identify costs specific to special education transportation, “only specialized tcase, the Vehicle ratio is not needed, and will not be available. This ratio determines the percentage ofservices in a district. A “Specialized Vehicle”school bus, van, or car that is designed to transport transportation needs in their IEP. a non-modified vehicles used on specialized rouTransportation Vehicle Ratio”, Numerator of the Specialized Vehicle RatioTo calculate the numerator, the “Total Number of Vehicles Used for Special Educationcount the number of vehicles specialized transportation needs in their IEP Denominator of the Specialized Vehicle RatioTo calculate the denominator, the “Total Number Vehicles Used for All Transportation”, count the number of vehicles in the district’s




To enter the Specialized Transportation Trips Ratio numerator and denominator,

. Select Cancel if any information has been entered

Specialized Transportation Vehicle Ratio

ed Transportation Vehicle Ratio is a required field for a district when “not transportation” costs are reported.

If a district can discreetly identify costs specific to special education transportation, “only specialized transportation” costs should always be reported.case, the Vehicle ratio is not needed, and will not be available.

determines the percentage of vehicles used for specialized transportation A “Specialized Vehicle” is defined as an adapted special needs

that is designed to transport students with specialized transportation needs in their IEP. Under certain circumstances, the district may include

modified vehicles used on specialized routes. To calculate the “Specialized Transportation Vehicle Ratio”, follow the instructions below.

of the Specialized Vehicle Ratio , the “Total Number of Vehicles Used for Special Education

used to transport special education studentsspecialized transportation needs in their IEP.

of the Specialized Vehicle Ratio To calculate the denominator, the “Total Number Vehicles Used for All Transportation”, ount the number of vehicles in the district’s fleet used for transportation.

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To enter the Specialized Transportation Trips Ratio numerator and denominator, select

if any information has been entered

is a required field for a district when “not

If a district can discreetly identify costs specific to special education ransportation” costs should always be reported. In this

vehicles used for specialized transportation special needs

students with specialized Under certain circumstances, the district may include

To calculate the “Specialized

, the “Total Number of Vehicles Used for Special Education”, transport special education students with

To calculate the denominator, the “Total Number Vehicles Used for All Transportation”, . This number


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would include both the specialized vehicles and the regular education vehiclesnumber should represent the total number of vehicles incurring costs reported on the Medicaid Cost Report. For example, if the district had specialized transportation, the Vehicle R To enter the Specialized Transportation Vehicle Ratio numerator and denominator, select Edit.

Enter both the numerator (“Total Number of Vehicles Used for Special Educationthe denominator (“Total Number of Vehicles Used for AllUpdate. Select Cancel if any

Individualized Education Program (IEP) Ratio The Individualized Education Program (IEP) Ratio used to apportion Medicaid allowable costs versus total special education costs for direct medical services. The IEP ratio is made up of the “with a prescribed Medical Service in the IEPSPED Students with a prescribed Medical Service in the IEPMedicaid eligible and non Medicaid eligible students Numerator of the IEP Ratio The numerator of the IEP Ratio is the Students with a prescribed Medical Service in the IEP




would include both the specialized vehicles and the regular education vehiclesshould represent the total number of vehicles incurring costs reported on the

f the district had ten total vehicles in their fleet and two were , the Vehicle Ratio would be reported as 2/10 or 20%

enter the Specialized Transportation Vehicle Ratio numerator and denominator,

Total Number of Vehicles Used for Special Education

Total Number of Vehicles Used for All Transportation”) then information has been entered erroneously.

Individualized Education Program (IEP) Ratio

Individualized Education Program (IEP) Ratio is a required field. The IEP Ratio is used to apportion Medicaid allowable costs versus total special education costs for

The IEP ratio is made up of the “Number of Unique Medicaid Eligible SPED Students with a prescribed Medical Service in the IEP” (numerator) and the “Number of Unique SPED Students with a prescribed Medical Service in the IEP” (denominatorMedicaid eligible and non Medicaid eligible students).

The numerator of the IEP Ratio is the number of “Unique Medicaid Eligible SPED Students with a prescribed Medical Service in the IEP”, including Attendant Care

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would include both the specialized vehicles and the regular education vehicles. This should represent the total number of vehicles incurring costs reported on the

were used for or 20%.

enter the Specialized Transportation Vehicle Ratio numerator and denominator,

Total Number of Vehicles Used for Special Education”) and ) then select

The IEP Ratio is used to apportion Medicaid allowable costs versus total special education costs for

SPED Students Number of Unique

(denominator - both

Unique Medicaid Eligible SPED Attendant Care


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Services, Counseling Services, Nursing Services, Occupational Therapy Services, Physical Therapy Services, Psychological Services, Social Work SeLanguage and Hearing Servicesthey are only counted once. To calculate the numerator of the IEP Ratio1. Take a running count of those students who w

education throughout the School yearin their IEP. The district must have documentation to support enrollment; OR,

2. Count the number of students enrolled in Medicaid day out of the reporting periodlisted in their IEP. This ratio would be a “snap shot” of those studentMedicaid and special education

Denominator of the IEP RatioThe denominator of the IEP Ratio is the prescribed Medical Service in their IEPServices, Nursing Services, Occupational Therapy Services, Physical Therapy Services, Psychological Services, Social Work Services and Speech Language and Hearing Services. If a student has more than one service in their IEP, they are only counted once. Note, this count includes both Medicaid eligible and non Medicaid eligible students. To calculate the denominator of the IEP Ratioconsistent and use method No. 1 or No. 2 for both the IEP Ratio numeratordenominator. 3. Take a running count of those students who were enrolled in

throughout any portion of the School yearlisted in their IEP. The district must have documentation to support enrollment; OR,

4. Count the number of students enrolled in special education onreporting period, such as 12/1/2011This ratio would be a “snap shot” of those studenta direct medical service in their IEP

To enter the IEP Ratio numerator and denominator,




Services, Counseling Services, Nursing Services, Occupational Therapy Services, Physical Therapy Services, Psychological Services, Social Work Services and Speech Language and Hearing Services. If a student has more than one service in their IEP,

of the IEP Ratio, follow one of two methods below.a running count of those students who were enrolled in Medicaid

throughout the School year with at least one direct medical service. The district must have documentation to support the students’

the number of students enrolled in Medicaid and special education onthe reporting period, such as 12/1/2011, with a direct medical service

This ratio would be a “snap shot” of those studentsecial education with a direct medical service in their IEP

of the IEP Ratio: The denominator of the IEP Ratio is the number of “Unique SPED Students with a prescribed Medical Service in their IEP”, including Attendant Care Services, Services, Nursing Services, Occupational Therapy Services, Physical Therapy Services, Psychological Services, Social Work Services and Speech Language and

. If a student has more than one service in their IEP, they are only . Note, this count includes both Medicaid eligible and non Medicaid

denominator of the IEP Ratio, follow one of two methods below. Be consistent and use method No. 1 or No. 2 for both the IEP Ratio numerator

a running count of those students who were enrolled in special educationthroughout any portion of the School year with at least one direct medical service

. The district must have documentation to support the students’

the number of students enrolled in special education on one day out of the orting period, such as 12/1/2011, with a direct medical service listed in their IEP

a “snap shot” of those students enrolled in special educationa direct medical service in their IEP.

numerator and denominator, select Edit.

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Services, Counseling Services, Nursing Services, Occupational Therapy Services, rvices and Speech

. If a student has more than one service in their IEP,

follow one of two methods below. Medicaid and special

direct medical service listed the students’

special education on one with a direct medical service

s enrolled in with a direct medical service in their IEP.

Unique SPED Students with a Attendant Care Services, Counseling

Services, Nursing Services, Occupational Therapy Services, Physical Therapy Services, Psychological Services, Social Work Services and Speech Language and

. If a student has more than one service in their IEP, they are only . Note, this count includes both Medicaid eligible and non Medicaid

follow one of two methods below. Be consistent and use method No. 1 or No. 2 for both the IEP Ratio numerator and

special education with at least one direct medical service

the students’

one day out of the with a direct medical service listed in their IEP.

lled in special education with


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Enter the numerator and denominatorinformation has been entered erroneously.




the numerator and denominator and select Update. Select Cancel if any information has been entered erroneously.

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if any


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III. Direct Medical Services Other Costs Summary To access the Direct Medical Services Other Costs SummaryServices Other Costs Summary

Once selected, the following page will appear.

The table on the Direct Medical Services Other Costs Summaryfor “Staff Travel for Training”, Medical Services” (materials and supplies Much of the information in the pre-populated based on information reported in the




Medical Services Other Costs Summary

Direct Medical Services Other Costs Summary, select Direct Medical Services Other Costs Summary link.

following page will appear.

Direct Medical Services Other Costs Summary displays reported costs , “Staff Professional Dues and Fees”, and “Other Direct

s and supplies).

Much of the information in the Direct Medical Services Other Costs Summaryon information reported in the Quarterly Other Costs

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Direct Medical

displays reported costs Other Direct

Direct Medical Services Other Costs Summary table is Quarterly Other Costs sections of


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the district’s Quarterly Financial Submissionon this page, including: “Quarterly Gross Staff Travel for Training CostsGross Staff Travel for Training Costs Federal RevenuesProfessional Dues and Fees” Federal Revenues”. These columns are marked in red below.

The two columns that can be edited on this page are Medical” and “Annual Gross Other Direct Medical Federal RevenueMedical Services Costs” is an auto calculation of thecolumns are marked in red below.

Under the “Annual Gross Other Direct Medical Onlyof entering costs for any materials and supplies usitems must be used for special education student services Additionally, for the “Annual Gross Other Direct Medical must be incurred for purchasingand Medicaid Services (CMS) Approved Materials and Supplies” listnext page. Items reported must be on this list, and must be used by special education students pursuant to IEP needs. Materials and Supplies used for genermedical purposes for special education should never be reported.




Quarterly Financial Submission reports. These columns are Quarterly Gross Staff Travel for Training Costs”,

Gross Staff Travel for Training Costs Federal Revenues”, “Quarterly Gross Staff and “Quarterly Gross Staff Professional Dues and Fees

. These columns are marked in red below.

be edited on this page are “Annual Gross Other Direct Annual Gross Other Direct Medical Federal Revenue”. The “

is an auto calculation of these preceding columns.columns are marked in red below.

Annual Gross Other Direct Medical Only” columns, the districtof entering costs for any materials and supplies used for direct medical services.

be used for special education student services.

Annual Gross Other Direct Medical Only” columns, these costs must be incurred for purchasing items that are identified on the “Centers for Medicare and Medicaid Services (CMS) Approved Materials and Supplies” list, provided

Items reported must be on this list, and must be used by special education students pursuant to IEP needs. Materials and Supplies used for general education and non medical purposes for special education should never be reported.

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columns are not editable , “Quarterly

Quarterly Gross Staff Quarterly Gross Staff Professional Dues and Fees

Annual Gross Other Direct The “Net Direct

preceding columns. These

district has the option ed for direct medical services. These

” columns, these costs s for Medicare

, provided on the

Items reported must be on this list, and must be used by special education students al education and non


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Centers for Medicare and Medicaid Services (CMS) Approved Materials and Supplies for Direct Medical Service

• Audiometer (calibrated annually), tympanometer

• Auditory, speech-reading, speechand communication instructional materials

• Bandages, including adhesive (e.g., bandaids) and elastic, of various

• Battery testers, hearing aid stethoscopes, and earmold cleaning materials

• Blood glucose meter • BMI calculator • Clinical audiometer with sound field

capabilities

• Cold packs • Cotton balls

• Cotton-tip applicators (swabs)• Current standardized tests and protocols;• Diapers and other incontinence supplies• Disposable gloves (latex-free)• Disposable gowns • Disposable suction unit

• Ear mold impression materials• Electroacoustic hearing aid analyzer• Electronic suction unit

• Evaluation tools (e.g., goniometers, dynamometers, cameras)

• Eye pads

• Fm amplification systems or other assistive listening devices

• Gauze

• Loaner or demonstration hearing aids




Centers for Medicare and Medicaid Services (CMS) Approved Materials and Supplies for

Audiometer (calibrated annually), • Otoscope

reading, speech-language, and communication instructional materials

• Otoscope/ophthalmoscope with battery

Bandages, including adhesive (e.g., band- • Peak flow meters

Battery testers, hearing aid stethoscopes, and earmold cleaning materials

• Physician’s scale that has a height rod and is balanced

• Portable acoustic immittance meter• Portable audiometer

Clinical audiometer with sound field • Positioning equipment bolsters, standers, adapted seating, exercise mats)

• Reflex hammer • Sanitary pads, individually wrapped (may

be used for compression)tip applicators (swabs) • Scales

Current standardized tests and protocols; • Scoliometer Diapers and other incontinence supplies • Slings

free) • Sound-level meter • Sound-treated test booth• Sphygmomanometer (calibrated

annually) and appropriate cuff sizesimpression materials • Splints (assorted)

Electroacoustic hearing aid analyzer • Stethoscope • Supplies for adapting materials and

equipment (e.g., strapping, Velcro, foam, splinting supplies)

Evaluation tools (e.g., goniometers, • Surgipads

• Syringes (medication administration / bolus feeding)

Fm amplification systems or other assistive • Technology devices (e.g., switches, computers, word processors, software)

• Test materials for central auditory processing assessment

Loaner or demonstration hearing aids • Test materials for screening speech and language, evaluating speech

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Centers for Medicare and Medicaid Services (CMS) Approved Materials and Supplies for

Otoscope/ophthalmoscope with battery

Physician’s scale that has a height rod

Portable acoustic immittance meter Portable audiometer Positioning equipment (e.g., wedges, bolsters, standers, adapted seating,

Sanitary pads, individually wrapped (may be used for compression)

treated test booth

Sphygmomanometer (calibrated annually) and appropriate cuff sizes

Supplies for adapting materials and equipment (e.g., strapping, Velcro, foam,

Syringes (medication administration /

Technology devices (e.g., switches, computers, word processors, software)

central auditory processing assessment Test materials for screening speech and language, evaluating speech-reading and


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• Materials for nonstandard, informal

assessment; • Materials used to assist students with range

of motion • Mobility equipment (e.g., walkers,

wheelchairs, scooters) • Nebulizers

To edit costs for “Annual Gross Other Direct MedicalMedical Federal Revenues”, select

Enter the appropriate figures for Other Direct Medical Federal Revenueshas been entered erroneously.

Once the “Annual Gross Other Direct MedicalFederal Revenues” have been updated for each desired service type, Report List at the upper left hand portion of the page to return to the main Medicaid Cost Report page.




evaluating auditory skills

Materials for nonstandard, informal

• Tongue depressors

Materials used to assist students with range • Triangular bandage

Mobility equipment (e.g., walkers, • Vision testing machine such as the Titmus

• Visual reinforcement audiometry equipment and other instruments necessary for assessing young or difficult-to-test children

• Wheelchair

Annual Gross Other Direct Medical” or “Annual Gross Other Direct select Edit to the left of the desired service type

the appropriate figures for “Annual Gross Other Direct Medical” or “Other Direct Medical Federal Revenues” select Update. Select Cancel if any information has been entered erroneously.

Annual Gross Other Direct Medical” and “Annual Gross Other Direct Medical have been updated for each desired service type, select

at the upper left hand portion of the page to return to the main Medicaid

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evaluating auditory skills

Tongue depressors

Triangular bandage

Vision testing machine such as the

Visual reinforcement audiometry equipment and other instruments

sary for assessing young or test children

Annual Gross Other Direct to the left of the desired service type.

“Annual Gross if any information

Annual Gross Other Direct Medical select Return to

at the upper left hand portion of the page to return to the main Medicaid


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IV. Direct Medical Services Equipment Depreciation To access the Direct Medical Services Equipment DepreciationMedical Services Equipment Depreciation


On this page, the district has the Depreciation for items on the approved CMS list that cost purchase price. These assets must be depreciated according to a This method assumes that the aanother. The annual depreciation is calculated by dividing the purchase price by the estimated useful life of the asset. MCRCS once the required fields Assets reported on the previouscarry over into this section.




Services Equipment Depreciation

Direct Medical Services Equipment Depreciation, select the Medical Services Equipment Depreciation link.

page will appear.

the district has the option of reporting Direct Medical Services Equipment for items on the approved CMS list that cost more than $5,000

depreciated according to a straight-line depreciation methodhat the asset loses an equal amount of value from one year to

The annual depreciation is calculated by dividing the purchase price by the estimated useful life of the asset. This calculation will automatically occur within

fields are entered.

n the previous fiscal year Medicaid Cost Report will automatically

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the Direct

Direct Medical Services Equipment more than $5,000 in

line depreciation method. ses an equal amount of value from one year to

The annual depreciation is calculated by dividing the purchase price by the This calculation will automatically occur within

Medicaid Cost Report will automatically


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Entering a New Asset To enter a new asset, begin entering information on

Then, follow the instructions below: Unique Asset ID: Insert a unique identifier for an asset.automatically into subsequent fiscal year reports for as long as the district is reporting depreciation on the asset.

Asset Type: Select an Asset Type that most closely depreciated from the drop down menu

Service Type: This column is populated with the allowable service type categories (Attendant Care Services, Counseling Services, Nursing Services, Occupational




begin entering information on the line marked with the

, follow the instructions below:

a unique identifier for an asset. This identifier will carry over automatically into subsequent fiscal year reports for as long as the district is reporting

: Select an Asset Type that most closely identifies the equipment being drop down menu.

This column is populated with the allowable service type categories (Attendant Care Services, Counseling Services, Nursing Services, Occupational

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marked with the Insert link.

will carry over automatically into subsequent fiscal year reports for as long as the district is reporting

the equipment being

This column is populated with the allowable service type categories (Attendant Care Services, Counseling Services, Nursing Services, Occupational


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Therapy Services, Physical Therapy Services, Psychological Services, Social Work Services and Speech Language that corresponds with the equipment being depreciated

Month Year Placed in Serviceinto service. This must be the date theitem was purchased. The date must be entered in the MM/YYYY format to be accepted. Month Year Removed From Service: removed from service. The date must be accepted.

Years of Useful Life: Enter the number of years of useful life for the particular piece of equipment. This number must be consistent with the district’s records. Cost: Enter the cost of acquiring the asset and preparing it for use. This number must be the full amount paid for the equipment regardless of the funding source. Federal Revenue: If the equipment was partially paid with federal funds, in this column, report the amount of federal dollars. The system will subtract the federal amount from the total amount to find the state and/or local costs. Notes: Enter any applicable notes relating to this asset type.




Therapy Services, Physical Therapy Services, Psychological Services, Social Work Services and Speech Language and Hearing Services). Select the service category that corresponds with the equipment being depreciated from the drop down menu.

Month Year Placed in Service: Enter the month and year the equipment was placed into service. This must be the date the item was placed into service and not the date the

The date must be entered in the MM/YYYY format to be accepted.

Month Year Removed From Service: Enter the month and year the equipment was The date must be entered in the MM/YYYY format to be

Enter the number of years of useful life for the particular piece of equipment. This number must be consistent with the district’s records.

Enter the cost of acquiring the asset and preparing it for use. This number must be the full amount paid for the equipment regardless of the funding source.

If the equipment was partially paid with federal funds, in this column, he amount of federal dollars. The system will subtract the federal amount from

find the state and/or local costs.

Enter any applicable notes relating to this asset type.

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Therapy Services, Physical Therapy Services, Psychological Services, Social Work and Hearing Services). Select the service category

the drop down menu.

: Enter the month and year the equipment was placed and not the date the


Enter the month and year the equipment was entered in the MM/YYYY format to be

Enter the number of years of useful life for the particular piece of

Enter the cost of acquiring the asset and preparing it for use. This number must be the full amount paid for the equipment regardless of the funding source.

If the equipment was partially paid with federal funds, in this column, he amount of federal dollars. The system will subtract the federal amount from


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Once the information has been entered,

The system will automatically calculate the prior period values based on the information Prior Period Accumulated Depreciationdepreciation that has accumulated between service and the beginning of the current cost reporting period. For cost purposes, this amount is calculated by month. Depreciation for Reporting Periodfor the applicable, current cost ra straight-line depreciation method.Medicaid allowable costs.




information has been entered, select Insert.

The system will automatically calculate the prior period and current period information entered.

Prior Period Accumulated Depreciation: This column displays the amount of accumulated between the time when the item was placed into

the beginning of the current cost reporting period. For cost reporting calculated by month.

Depreciation for Reporting Period: This column displays the amount of depreciatifor the applicable, current cost reporting period. This number is calculated according to

line depreciation method. This figure will be factored into the district’s total

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and current period depreciation

the amount of when the item was placed into

reporting

t of depreciation . This number is calculated according to

This figure will be factored into the district’s total


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Editing and Deleting Reported Assets If an asset’s information needs to be editedreported asset. When the edit has been made,

If an asset needs to be deletedOK to complete the deletion.

Once this information has been upper left hand portion of the page to return to the main




Deleting Reported Assets

’s information needs to be edited, select the Edit link found to theWhen the edit has been made, select Update, as shown previously

needs to be deleted, select Delete to the left of the reported asset

Once this information has been updated, select the Return to Report List upper left hand portion of the page to return to the main Medicaid Cost Report

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the left of the , as shown previously.

reported asset. Select

Return to Report List link at the Medicaid Cost Report page.


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V. Transportation Payroll Information Transportation Payroll costs can be reported for Bus Aides, Bus Drivers, and Mechanics Assistance who work with specialized vehicles. These vehicles must be used for transportation services provided to transportation needs, as identified in the IEP. To access the Transportation Payroll Informationselect the Transportation Payroll Information

The following screen will appear

Transportation Payroll Staff are only reported on an annual basis on the Medicaid Cost Report. These individuals are not reported on a quarterly basis nor are they eligible to be selected for a Random Moment Time Study (RMTS). Only Bus Mechanics, and Mechanics Assistants are allowable. To add an individual, following the instructions below:




Payroll Information

Transportation Payroll costs can be reported for Bus Aides, Bus Drivers, Assistance who work with specialized vehicles. These vehicles must be

ortation services provided to special education students for specialized transportation needs, as identified in the IEP.

Transportation Payroll Information portion of the Medicaid Cost ReportTransportation Payroll Information link.

will appear.

Transportation Payroll Staff are only reported on an annual basis on the Medicaid Cost Report. These individuals are not reported on a quarterly basis nor are they eligible to be selected for a Random Moment Time Study (RMTS). Only Bus Aides, Mechanics, and Mechanics Assistants are allowable.

ollowing the instructions below:

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Transportation Payroll costs can be reported for Bus Aides, Bus Drivers, Mechanics, Assistance who work with specialized vehicles. These vehicles must be

for specialized


Transportation Payroll Staff are only reported on an annual basis on the Medicaid Cost Report. These individuals are not reported on a quarterly basis nor are they eligible to

Aides, Drivers,


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Last Name and First Name: Enter the individual’s last name and first name.

Job Category: Select the individual’sMechanic Assistant) from the job category drop down Under the drop down menu, the district must also pertains to “only specialized transportation” or “not district can discreetly identify the portion of the individual’s costs that pertain specifically to special education student servicescategory. If the district cannot discreetly idepertain to special education student servicestransportation” category. For example, a mechanic works on all education and special educationpayroll information into specialized transportation mechanic services and regular transportation mechanic services, the specialized transportation” category.

Staff Employment Status: Select their Staff Employment Status (Full Time or Part Time) from the drop down.




Enter the individual’s last name and first name.

individual’s job category (Bus Aide, Bus Driver, Mechanic, or Mechanic Assistant) from the job category drop down menu.

, the district must also identify whether the individual “only specialized transportation” or “not only specialized transportation

the portion of the individual’s costs that pertain specifically education student services, select the “only specialized transportation”

category. If the district cannot discreetly identify the portion of the individual’s costs that student services, select the “not only specialized

mechanic works on all vehicles in the district’s fleet, both ecial education vehicles. If the district cannot separate the mechanic’s

payroll information into specialized transportation mechanic services and regular tion mechanic services, the mechanic would be reported under the “not only

nsportation” category.

Select their Staff Employment Status (Full Time or Part

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Enter the individual’s last name and first name.

job category (Bus Aide, Bus Driver, Mechanic, or

identify whether the individual ized transportation”. If a

the portion of the individual’s costs that pertain specifically , select the “only specialized transportation”

the portion of the individual’s costs that , select the “not only specialized

regular separate the mechanic’s

payroll information into specialized transportation mechanic services and regular mechanic would be reported under the “not only

Select their Staff Employment Status (Full Time or Part


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District Job Title and District Employee ID: by the district, as well as the Employee ID.

Paid Hours, Salaries, and Benefit Informationand benefit information for the cost reporting period in the appropriate fields.

Compensation Federal Revenuescompensation paid for by federal funds. This amount will be subtracted from the gross reported costs.

Once completed, select Insert

Once all Transportation Payroll Information List at the upper left hand portion of the page to return to the main Report page.




District Employee ID: Enter the individual’s Job Title, as titled the Employee ID.

Benefit Information: Enter the paid hours, annual salaryand benefit information for the cost reporting period in the appropriate fields.

Compensation Federal Revenues: Enter, if applicable, any amount of the individualcompensation paid for by federal funds. This amount will be subtracted from the gross

Insert.

Transportation Payroll Information has been inserted, select Return to Report at the upper left hand portion of the page to return to the main Medicaid Cost

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s Job Title, as titled

annual salary, and benefit information for the cost reporting period in the appropriate fields.

of the individual’s compensation paid for by federal funds. This amount will be subtracted from the gross

Return to Report

Medicaid Cost


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VI. Transportation Other Costs To access the Transportation Other Coststhe Medicaid Cost Report linkTransportation Other Costs link.related to special education transportation on the cost report. Transportation Other Costs includes costs associated with:

• Lease/Rental; • Insurance; • Maintenance and Repairs;• Fuel and Oil; • Major Purchases under $5,000;• Purchased Professional S• Purchased Professional Services• Other.

To access this portion of the Medicaid Cost Report




Transportation Other Costs

Transportation Other Costs portion of the Medicaid Cost Reportlink at the top of the menu screen, then select the

link. This section allows the district to enter other costs related to special education transportation on the cost report.

includes costs associated with:

Maintenance and Repairs;

Major Purchases under $5,000; Purchased Professional Services-Transportation Services; Purchased Professional Services-Transportation Equipment; and,

Medicaid Cost Report, select Transportation Other Costs

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Medicaid Cost Report, select the

district to enter other costs

Transportation Other Costs.


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The top portion of this page is used to report costs associated with “not only specialized transportation”. The bottom portion of the page is used to report costs the district can discreetly identify as “only specialized trathe district must categorize the costs asspecialized transportation”. Do categories. This will lead to duplicative claiming. Only Specialized TransportationIf a district can discreetly identify education, select the “only specialized transportation” category. Not Only Specialized TransportationIf the district cannot discreetly identify the “not only specialized transportation” category.situations where a district is unable to identregular education student transportation services.




The top portion of this page is used to report costs associated with “not only specialized transportation”. The bottom portion of the page is used to report costs the district can discreetly identify as “only specialized transportation”. For each Other Cost

categorize the costs as “not only specialized transportation” or Do not report the same cost twice under differen

categories. This will lead to duplicative claiming.

Only Specialized Transportation If a district can discreetly identify the transportation costs used specifically for special education, select the “only specialized transportation” category.

Only Specialized Transportation discreetly identify transportation costs for special education, select

the “not only specialized transportation” category. This category exists for those unable to identify and separate costs between special and

regular education student transportation services.

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The top portion of this page is used to report costs associated with “not only specialized transportation”. The bottom portion of the page is used to report costs the district can

Other Cost reported, tion” or “only

under different

costs used specifically for special

costs for special education, select This category exists for those

between special and


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For example, a district would like to report fuel costs on the Medicaid Cost Report. However, the district does not discreetly capture fuel costs for specialized transportation vehicles. The district has documentation for the vehicles but cannot separate how much of the cost pertains specifically to fuel consumed by general vehicles or specialized vehicles. In this scenariowould report the fuel costs as “not only specialized transportation”. To report Transportation Other Costs

Once all cost information for a particular row

Continue to complete the information, row by row.




a district would like to report fuel costs on the Medicaid Cost Report. does not discreetly capture fuel costs for specialized transportation

vehicles. The district has documentation for the total amount spent for fuel for vehicles but cannot separate how much of the cost pertains specifically to fuel

es or specialized vehicles. In this scenario, the district would report the fuel costs as “not only specialized transportation”.

Transportation Other Costs, select Edit.

for a particular row is complete, select Update.

Continue to complete the information, row by row.

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a district would like to report fuel costs on the Medicaid Cost Report. does not discreetly capture fuel costs for specialized transportation

amount spent for fuel for all vehicles but cannot separate how much of the cost pertains specifically to fuel

, the district


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Select Return to Report List at the upper left hand portion of the page to return to the main Medicaid Cost Report page.




at the upper left hand portion of the page to return to the page.

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at the upper left hand portion of the page to return to the


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VII. Transportation Equipment Depreciation On the Transportation Equipment Depreciationthe opportunity to report any depreciation costs related to special education transportation assets that cost more than $5,000. This includes Minivans, Harnesses/Seatbelts/Child protective seating, Light Trucks and Vans, Vehicle Air Conditioning, Wheelchair L These assets must be depreciated according to a This method assumes that the asset loanother. The annual depreciation is calculated by dividing the purchase price by the estimated useful life of the asset. MCRCS once the required fields Items reported in the previous over into this section. To access this portion of the cost report, from the main Medicaid Cost Report




Transportation Equipment Depreciation

Transportation Equipment Depreciation section of the cost report, the district has the opportunity to report any depreciation costs related to special education transportation assets that cost more than $5,000. This includes Buses, Cars and

Harnesses/Seatbelts/Child protective seating, Light Trucks and Vans, Vehicle Lift and Other items.

These assets must be depreciated according to a straight-line depreciation methodethod assumes that the asset loses an equal amount of value from one year to

The annual depreciation is calculated by dividing the purchase price by the estimated useful life of the asset. This calculation will automatically occur within

required fields are entered.

Items reported in the previous fiscal year Medicaid Cost Report will automatically carry

To access this portion of the cost report, select Transportation Equipment DepreciationMedicaid Cost Report page.

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section of the cost report, the district has the opportunity to report any depreciation costs related to special education

Cars and Harnesses/Seatbelts/Child protective seating, Light Trucks and Vans, Vehicle

line depreciation method. n equal amount of value from one year to

The annual depreciation is calculated by dividing the purchase price by the This calculation will automatically occur within

Medicaid Cost Report will automatically carry

portation Equipment Depreciation


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To enter a new asset, start by entering information into the line Unique Asset ID: Insert a unique identifier for theautomatically into subsequent fiscal year reports for as long as the district is reporting depreciation on the asset.

Asset Type T: This column is populated with the allowable service type categories (Buses, Cars and Minivans, Harnesses/Seatbelts/child protective seatinand Vans, Other – please describe, Vehicle Air Conditioning, and Wheelchair LiftSelect an Asset Type that most closely categorizes the drop down menu.




the following page will appear.

To enter a new asset, start by entering information into the line item with the

a unique identifier for the asset. This will carry over subsequent fiscal year reports for as long as the district is reporting

This column is populated with the allowable service type categories Buses, Cars and Minivans, Harnesses/Seatbelts/child protective seating, Light Trucks

please describe, Vehicle Air Conditioning, and Wheelchair LiftSelect an Asset Type that most closely categorizes the asset being depreciated

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with the Insert link.

This will carry over subsequent fiscal year reports for as long as the district is reporting

This column is populated with the allowable service type categories g, Light Trucks

please describe, Vehicle Air Conditioning, and Wheelchair Lift). being depreciated from a


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Service Type T: Select the service category that corresponds with the depreciated from the drop down specialized transportation”. If a district can discreetly special education student servicesIf the district cannot discreetly student services (purchased for both special education and regular educationthe “not only specialized transportation” category.

Month Year Placed in Serviceservice. This must be the date the item was item was purchased. The date must be entered in the MM/YYYY format to be accepted. Month Year Removed From Service: removed from service. The date must be entered in the MM/YYYY format to be accepted.

Years of Useful Life: Enter the number of years of useful life for must be consistent with the district’s accounting records. Cost: Enter the cost of acquiring the be the full amount paid for the




Select the service category that corresponds with the assetthe drop down menu “only specialized transportation” or “not

If a district can discreetly identify that the asset pertains to education student services, select the “only specialized transportation” category.

discreetly identify that the asset pertains to special education purchased for both special education and regular education

the “not only specialized transportation” category.

Month Year Placed in Service: Enter the month and year the asset was placed into

This must be the date the item was placed into service and not the date the The date must be entered in the MM/YYYY format to be accepted.

Month Year Removed From Service: Enter the month and year the assetThe date must be entered in the MM/YYYY format to be

Enter the number of years of useful life for asset. This number must be consistent with the district’s accounting records.

Enter the cost of acquiring the asset and preparing it for use. This number must be the full amount paid for the vehicle regardless of the funding source.

Page | 33

asset being “only specialized transportation” or “not only

identify that the asset pertains to , select the “only specialized transportation” category.

education purchased for both special education and regular education) select

was placed into and not the date the


asset was The date must be entered in the MM/YYYY format to be

. This number

and preparing it for use. This number must


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Federal Revenue: If the assetreport the amount of federal dollars. The system will subtract the federal amount from the total amount to find the state and/or loca Notes: Enter any applicable notes relating to this asset type.

Once all information is entered

Prior Period Accumulated Depreciationdepreciation that has accumulated between service and the beginning of thpurposes, this amount is calculated by month. Depreciation for Reporting Periodfor the applicable, current cost ra straight-line depreciation method. Medicaid allowable costs.




asset was partially paid with federal funds, in this column, report the amount of federal dollars. The system will subtract the federal amount from

find the state and/or local costs.

Enter any applicable notes relating to this asset type.

entered, select Insert.

Prior Period Accumulated Depreciation: This column displays the amount of accumulated between the time when the item was placed into

the beginning of the current cost reporting period. For cost reporting calculated by month.

Depreciation for Reporting Period: This column displays the amount of depreciatir the applicable, current cost reporting period. This number is calculated according to

line depreciation method. This figure will be factored into the district’s total

Page | 34

was partially paid with federal funds, in this column, report the amount of federal dollars. The system will subtract the federal amount from

the amount of when the item was placed into

reporting

the amount of depreciation . This number is calculated according to

This figure will be factored into the district’s total


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Once all items have been entered, portion of the page to return to the main




have been entered, select Return to Report List at the upper left hand portion of the page to return to the main Medicaid Cost Report page.

Page | 35

at the upper left hand


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VII. Salary and Benefits Data Summary Report

To access the Salary and Benefits Data Summary ReportReport, select the Salary and Benefits Data Summary Repor On the Salary and Benefits Data Summary Reportopportunity to review the aggregated Submissions. This information is organizebenefit information for direct medical service providers rolls into the Report.





Salary and Benefits Data Summary Report

Salary and Benefits Data Summary Report portion of the Medicaid Cost Salary and Benefits Data Summary Report link.

Salary and Benefits Data Summary Report section, the district has the opportunity to review the aggregated costs reported on the Quarterly Financial

. This information is organized by Job Category. Note, only the salary and benefit information for direct medical service providers rolls into the Medicaid Cost

ed, the following page will appear.

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Medicaid Cost

section, the district has the Quarterly Financial

Note, only the salary and Medicaid Cost


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After the Salary and Benefits Data Summary ReportReturn to Report List at the upper left hand portion of the page to return to the main Medicaid Cost Report page.




Salary and Benefits Data Summary Report page has been reviewedat the upper left hand portion of the page to return to the main

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been reviewed, select at the upper left hand portion of the page to return to the main


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VIII. Annual Edits To access the Annual Edits portion of the link. On the Annual Edits section of the cost report, the district has the and or resolved auto-generated system reviewing the reported information for common errors.

Once selected, the Annual Edits




portion of the Medicaid Cost Report, select the

section of the cost report, the district has the opportunity to generated concerns, called “edits”, triggered as a result of the

system reviewing the reported information for common errors.

Annual Edits page will appear:

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the Annual Edits

opportunity to explain as a result of the


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This page will list edits that were identified proceed to the Claims Verification and Submissionaddress each one individually. There are three levels of edit checks in the system

• Level 1: This type of edit check wentering it directly into the system. An error message will appear, describing the error and how to correct it.

• Level 2: This type of edit check will flagallow the district to provide Level 2 edits.

• Level 3: This type of edit check The entry must be corrected before certification occurs. The lists any Level 3 edits.

To resolve the edit listed on the

• Enter a sufficient explanation into the • Correct the flagged information

To do so, select Edit.

Determine whether or not the edit needs




that were identified by the system. If no edits were identified, Claims Verification and Submission page. If edits were identified,

individually.

checks in the system.

edit check will not allow information to be saved when entering it directly into the system. An error message will appear, describing the error and how to correct it.

edit check will flag something unexpected. The system will the district to provide an explanation. The Annual Edits page

his type of edit check will not allow the flagged entry to be certified. must be corrected before certification occurs. The Annual Edit

listed on the Annual Edits page, the user must:

explanation into the appropriate field, if applicableflagged information.

the edit needs to be corrected or can be explained.

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If no edits were identified, If edits were identified,

ill not allow information to be saved when entering it directly into the system. An error message will appear, describing the

something unexpected. The system will page will list any

the flagged entry to be certified. Annual Edits page

, if applicable; Or,

to be corrected or can be explained.


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For this example, we will provide an explanationexplained the edit, then select

Once updated, the explanation appears.

Once all Annual Edits have been addressed and resolved“Annual Edits Resolved” will display




For this example, we will provide an explanation, seen below. After the user has select Update.

Once updated, the explanation appears.

have been addressed and resolved, a green dot with thal Edits Resolved” will display.

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After the user has

a green dot with the banner


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Examples of common edits include

• No annual payroll information• Reporting salaries higher than expected thresholds• Reporting more federal funding costs than total costs

Select Return to Report List at the upper left hand portion of the page to return to the main Medicaid Cost Report page.




include:

o annual payroll information (Level 2); eporting salaries higher than expected thresholds (Level 2); eporting more federal funding costs than total costs (Level 3).

at the upper left hand portion of the page to return to the page.

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at the upper left hand portion of the page to return to the


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IX. Claims Verification and Submission The Claims Verification and Submissionthis page the system aggregates the reported information, applies the Unrestricted Indirect Cost Rate and applicable ratios, and calculates the Costs. On this page, the district will certify their To access the Claims Verification and Submissionselect the Claims Verification and Submission




Claims Verification and Submission

Claims Verification and Submission page summarizes the reported informationthis page the system aggregates the reported information, applies the Unrestricted Indirect Cost Rate and applicable ratios, and calculates the Total Medicaid Allowable

certify their Medicaid Cost Report.

Claims Verification and Submission portion of the Medicaid Cost ReportClaims Verification and Submission link.

Page | 42

reported information. On this page the system aggregates the reported information, applies the Unrestricted

Total Medicaid Allowable



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The following page will appear:




The following page will appear:

Page | 43


Settlement Training



The reported Direct Medical Servicespercentages to determine the

1. Unrestricted Indirect Cost Rate (UICR) 2. IEP Ratio 3. Direct Medical Service

The reported Transportation Servicespercentages to determine the Transportation

1. Unrestricted Indirect Cost Rate (UICR) 2. Transportation Trip Ratio3. Transportation Vehicle Ratio

Once the Claims Verification and Submissionbutton on the bottom left hand corner, titled shown below. This submits the

Once selected, the system will display a




Direct Medical Services Total Costs are apportioned by three Direct Medical Medicaid Allowable Costs:

Unrestricted Indirect Cost Rate (UICR)

Service Percentage

Transportation Services Total Costs are apportioned by twothe Transportation Medicaid Allowable Costs:

Unrestricted Indirect Cost Rate (UICR) Transportation Trip Ratio Transportation Vehicle Ratio

Claims Verification and Submission information has been reviewed, button on the bottom left hand corner, titled “Select to certify Medicaid cost reportshown below. This submits the Medicaid Cost Report.

ed, the system will display a green colored dot with the status

Page | 44

by three

two or three

reviewed, select the to certify Medicaid cost report”, as

with the status Certified.


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After the Claims Verification and Submissioncertified, select Return to Report Listto the main Medicaid Cost Report page.




Claims Verification and Submission has been reviewed and the cost report Return to Report List at the upper left hand portion of the page to return

to the main Medicaid Cost Report page.

Page | 45

has been reviewed and the cost report at the upper left hand portion of the page to return


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X. Signature Page

To access the Signature PagePage link. The district must print, sign and submit the

Once selected, the district user will be brought to the the next page. The Total Computable, or Expenditures submitted to Health Services (DHS) for SY12 School Based Services (SBS) Medicaid Servicesis the aggregate of all costs the these costs have been apportioned




Page portion of the Medicaid Cost Report, select

district must print, sign and submit the Signature Page to Public Consulting Group.

user will be brought to the Signature Page form

Expenditures submitted to the Wisconsin Department of (DHS) for SY12 School Based Services (SBS) Medicaid Services

the district reported on the Medicaid Cost Reportapportioned by the reported statistical information.

Page | 46

select the Signature

to Public Consulting Group.

form, shown on

the Wisconsin Department of (DHS) for SY12 School Based Services (SBS) Medicaid Services,

Medicaid Cost Report. Note, statistical information.


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Page | 47


Settlement Training



Print the Signature Page form

The form must be signed by the other appropriate Agent at the district. Authority” at the bottom of the form.

Complete the fields on the Signature Page formof Signer, Title of Signer, Address of Signer,




form.

by the district’s CFO, Superintendent, Business Officer or Agent at the district. Mark the district employee with “Signature

Authority” at the bottom of the form.

Complete the fields on the Signature Page form, including: Date, Printed/Typed Name Title of Signer, Address of Signer, Phone Number, Fax Number,

Page | 48

CFO, Superintendent, Business Officer or district employee with “Signature

rinted/Typed Name Phone Number, Fax Number, and Email.


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After the Signature Page form has been signed, make a copy for the

Mail the original copy of the may be scanned and emailed or faxed, but the PCG.

FAX: 512-407-9249

PCG will then take the information reported on the Medicaid Cost Report and comprehensive desk review. outstanding concerns regarding their reported information. Once the desk review is complete, PCG will Medicaid Paid Claims data. The district will be notifsettlement results have been released and are ready to be reviewed in the system. See Part 2 of this guide to learn more.

District Address




form has been signed, make a copy for the district

the Signature Page form to the address below. The document scanned and emailed or faxed, but the district must mail the original

9249 EMAIL: [email protected]

PCG will then take the information reported on the Medicaid Cost Report and comprehensive desk review. PCG will contact the district via email if there are any outstanding concerns regarding their reported information.

Once the desk review is complete, PCG will compute the cost settlement. The district will be notified via email when the cost

settlement results have been released and are ready to be reviewed in the system. See Part 2 of this guide to learn more.

Public Consulting Group, Inc.

ATTN: 11/12 Cost Report 504 Lavaca Street, Suite 930

Austin, TX 78701-2900

Address

Page | 49

district’s records.

form to the address below. The document original copy to

[email protected]

PCG will then take the information reported on the Medicaid Cost Report and conduct a PCG will contact the district via email if there are any

compute the cost settlement results using ied via email when the cost

settlement results have been released and are ready to be reviewed in the system. See


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Part 2: Cost Settlement




Settlement

Page | 50


Settlement Training



I. Releasing of the Cost Settlement ResultsPCG uses the Medicaid Paid Claims data toWhen these results are ready to be viewed in the system, PCG will send the district an email indicating they can access Summary and the Cost Settlement Before releasing of the cost settlement results:

After releasing of the cost settlement results:




I. Releasing of the Cost Settlement Results Paid Claims data to calculates the cost settlement results.

When these results are ready to be viewed in the system, PCG will send the district an email indicating they can access the active links on MCRCS, the Medicaid Paid Claims

ettlement page.

Before releasing of the cost settlement results:

After releasing of the cost settlement results:

Page | 51

the cost settlement results. When these results are ready to be viewed in the system, PCG will send the district an

Medicaid Paid Claims


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II. Medicaid Paid Claims Summary To access the Medicaid Paid Claims Summaryselect the Medicaid Paid Claims Summary

The following page, with data uniqu

The Medicaid Paid Claims Summarytheir aggregated Medicaid fee




Medicaid Paid Claims Summary

Medicaid Paid Claims Summary page of the Medicaid Cost ReportMedicaid Paid Claims Summary link.

The following page, with data unique to each district, will appear.

Medicaid Paid Claims Summary page gives the district the opportunity to review their aggregated Medicaid fee-for-service paid claims that the district received

Page | 52


gives the district the opportunity to review service paid claims that the district received


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throughout the reporting period. These paid claims are based on datethe cost reporting period.

After the Medicaid Paid Claims SummaryList at the upper left hand portion of the page to return to the main Report page.




throughout the reporting period. These paid claims are based on date-of

aid Paid Claims Summary has been reviewed, select Return to Report at the upper left hand portion of the page to return to the main Medicaid Cost

Page | 53

of-service within

Return to Report Medicaid Cost


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III. Cost Settlement To access the Cost SettlementSettlement link.

The following page will appear.




Cost Settlement portion of the Medicaid Cost Report, select

e following page will appear.

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select the Cost


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Page | 55


Settlement Training



The Cost Settlement page willtheir final cost settlement.




will give the district the opportunity to review and approve

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give the district the opportunity to review and approve


Settlement Training



Understanding the Cost Settlement Each section below illustrates the and provides a walk through on how to understand the calculation. sections in total, Sections A through F. Section A, Total Computable Medicaid Costs

1. Total Computable Direct Medical Services Costs: This

total Direct Medical costs the district reported on the 2. Total Computable Specialized Transportation Costs: This figure is the sum of the

total Transportation costs the district 3. Total Computable Medicaid Costs: This figure is the sum of the total

Medical and Transportation costs the district reported on the Report.

Section B, Federal Financial Participation Ra

4. The federal government reimburses states for a portion of their allowable

expenditures. This reimbursement is called the Federal Financial Participation Rate (FFP). This reimburpercentage is 60.44%.

Section C, Total Computable Medicaid Cost Federal Share Only

5. Total Computable Medicaid Cost Federal Share Only: The calculation applies the

FFP rate to the Total Computable costs (Line 3), resulting in this figure. Line 5 = Line 3 * Line 4 =

$191,873.99 * $115,986.64




Understanding the Cost Settlement Calculation

Each section below illustrates the Cost Settlement page found on the MCRCS website and provides a walk through on how to understand the calculation. There are six

A through F.

, Total Computable Medicaid Costs

Total Computable Direct Medical Services Costs: This figure is the sum of the costs the district reported on the Medicaid Cost Report.

Total Computable Specialized Transportation Costs: This figure is the sum of the costs the district on the Medicaid Cost Report.

Total Computable Medicaid Costs: This figure is the sum of the total Medical and Transportation costs the district reported on the Medicaid Cost

, Federal Financial Participation Rate

The federal government reimburses states for a portion of their allowable expenditures. This reimbursement is called the Federal Financial Participation Rate (FFP). This reimbursement is based on a percentage. In this case, the

Section C, Total Computable Medicaid Cost Federal Share Only

Total Computable Medicaid Cost Federal Share Only: The calculation applies the FFP rate to the Total Computable costs (Line 3), resulting in this figure.

Line 3 * Line 4 = $191,873.99 * 60.44% = $115,986.64

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page found on the MCRCS website There are six

figure is the sum of the Medicaid Cost Report.

Total Computable Specialized Transportation Costs: This figure is the sum of the the Medicaid Cost Report.

Total Computable Medicaid Costs: This figure is the sum of the total Direct Medicaid Cost

The federal government reimburses states for a portion of their allowable expenditures. This reimbursement is called the Federal Financial Participation

is case, the

Total Computable Medicaid Cost Federal Share Only: The calculation applies the FFP rate to the Total Computable costs (Line 3), resulting in this figure.


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Section D, Total Medicaid Interim Payments Received

6. Medicaid Interim Payments Received (District Share)7. Medicaid Interim Payments Received (State Share)8. Total Medicaid Interim Payments Received: This

interim payments received for services provided during the cost reporting period. This figure includes both the federal and state share amounts and is based on date-of-service. Line 8 = Line 6 + Line 7 $32,613.72 + $54,356.20

Section E, Difference Between Total Computable and Medicaid Interim Payments

9. Difference Between Total Computable and Medicaid Interim Payments

figure is the difference between the Total Computable amountMedical and Transportation Costs, apportioned by the FFP rate) Medicaid interim payment Line 9 = Line 5 – Line 8 = $115,986.64 $61,612.44

Section F, Cost Settlement Amount Due to/from the Provider




Section D, Total Medicaid Interim Payments Received

Medicaid Interim Payments Received (District Share) Medicaid Interim Payments Received (State Share) Total Medicaid Interim Payments Received: This figure is the sum

received for services provided during the cost reporting period. This figure includes both the federal and state share amounts and is based on

Line 6 + Line 7 = $32,613.72 + $21,742.48 =

E, Difference Between Total Computable and Medicaid Interim Payments

Difference Between Total Computable and Medicaid Interim Paymentsfigure is the difference between the Total Computable amount (the total Direct Medical and Transportation Costs, apportioned by the FFP rate) and the Medicaid interim payments received.

Line 8 = $115,986.64- $54,356.20 =

Amount Due to/from the Provider

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figure is the sum of all Medicaid received for services provided during the cost reporting period.

This figure includes both the federal and state share amounts and is based on

E, Difference Between Total Computable and Medicaid Interim Payments

Difference Between Total Computable and Medicaid Interim Payments: This (the total Direct

and the


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10. Cost Settlement Amount Due to or from Provider (District Share): This figure is

the amount that will be paid to the district or is owed from the district. If the number is positive, it is a payment. If the number is negative (in parenthesis), it is a recoupment. The district is paid/owed 60% of the difference between the Total Computable and the Medicaid Interim Payments received. Line 10 = Line 9 * 60% = $61,612.44 * 60% = $36,967.46

11. Cost Settlement Amount Due to or from Provider (State Share):

displayed for information purposes only. Thedifference between the Total Computable and the Medicaid Interim Payments received.

Line 11 = Line 9 * 40% =

$61,612.44 * 4 $24,644.98




Cost Settlement Amount Due to or from Provider (District Share): This figure is the amount that will be paid to the district or is owed from the district. If the number is positive, it is a payment. If the number is negative (in parenthesis), it

a recoupment. The district is paid/owed 60% of the difference between the Total Computable and the Medicaid Interim Payments received.

Line 10 = Line 9 * 60% = * 60% =

Cost Settlement Amount Due to or from Provider (State Share): This figure is displayed for information purposes only. The state is responsible for 40% of the difference between the Total Computable and the Medicaid Interim Payments

Line 11 = Line 9 * 40% = * 40% =

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Cost Settlement Amount Due to or from Provider (District Share): This figure is the amount that will be paid to the district or is owed from the district. If the number is positive, it is a payment. If the number is negative (in parenthesis), it

a recoupment. The district is paid/owed 60% of the difference between the

This figure is state is responsible for 40% of the

difference between the Total Computable and the Medicaid Interim Payments


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Approving the Cost Settlement Once the Cost Settlement information has been reviewedin the system by scrolling to the bottom of the

Once the cost settlement is approved, the status of the change to Reconciled.

At this point, the district has completed all necessary steps in the cost settlement process. The Wisconsin Department of Health Services will payments and recoupment’s within 24 months after the cost settlement fiscal year.




Cost Settlement in MCRCS

information has been reviewed, approve the cost settlement in the system by scrolling to the bottom of the Cost Settlement page. Select

Once the cost settlement is approved, the status of the Medicaid Cost Report

has completed all necessary steps in the cost settlement . The Wisconsin Department of Health Services will process all district

recoupment’s within 24 months after the cost settlement fiscal year.

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approve the cost settlement Select Approve.

Medicaid Cost Report will

has completed all necessary steps in the cost settlement district

recoupment’s within 24 months after the cost settlement fiscal year.

Documents

Wisconsin School-Based Services Medicaid Cost Report and Cost … · 2012-11-19 · Wisconsin School-Based Services Medicaid Cost Report and Cost Settlement Training Guide September